Presidential address

(What he should be saying....)

My fellow Americans:

I asked for your time this evening to speak with you about the health care debate in Washington and town hall meetings, websites, and radio and TV shows all across America.

First, let me say how proud I am to be an American and, along with you, to be a citizen of this great country, where our rights to express our views and opinions freely and without reservation about health care reform or any other topic are guaranteed to each of us by our Constitution. When I became president, I took an oath to preserve and protect that Constitution, and I pledge to do everything in my power to ensure that your rights to express your views, no matter how widely shared or difficult they may be for others of us to understand and accept, are protected.

My hope is that each American will respect the right of all Americans to be heard on this issue. However, we cannot listen to each other when we are shouting at each other or distorting the facts with inflammatory rhetoric. It is not the American way. So let's have a lively and vigorous debate but with an attitude of moderation and respect for all.

That being said, I believe it is now time for me to be clear with you about the choices we now have in this great national health care discussion, and to share my views about how we go forward, together, as one nation, to arrive at a solution that is fair, affordable, and durable for us all.

In many respects, our health care system continues to be a world leader. Our doctors, nurses, hospitals, pharmaceutical companies, research centers, and medical schools are the finest in the world, and, for those who have access to our medical system, the treatments, drugs, technology, and therapies available today are curing the sick, prolonging life, and improving the quality of life for most, though not all, of our fellow citizens.

However, my friends, we face two big challenges that we have to address now, this year, if we are going to maintain and improve the best health care system in the world: Number One is the harsh truth that nearly 50 million Americans---1 person in 5 among those younger than 65-- have no medical coverage at all and cannot afford even basic medical care that the rest of us get through our employers, Medicare, and other programs. In each community, too many families seek routine care in overcrowded, understaffed hospital emergency rooms when their kids or a parent have a cough or a fever or a swollen ankle that just can't seem to get better. Or they wait until the cough or the fever gets worse, untreated, until it becomes a real emergency. These families routinely face choices none of us should be asked to make: can I pay the rent or put enough food on the table this week if I pay for the prescriptions a doctor has ordered for my child or a beloved parent or grandparent.

It is not acceptable that we have a health care system where a large and growing number of our fellow Americans are treated as second class citizens. I will not accept any reform proposals that do not specifically provide affordable health insurance for all of our citizens.

All is not well, either, for the rest of you under 65, whose doctors visits, medications, or hospital stays are paid by private insurance. If you lose your job, or your employer can no longer afford to provide medical insurance, or your private insurance company refuses to pay for essential medicines or treatments because of pre-existing conditions or other reasons--any of these exposes you to great risk to your financial and physical well-being.

The fact is that, under current conditions, getting sick in America too often means the beginning of an administrative and financial nightmare. This is not an acceptable way forward, and our plan must address these challenges, too, in order for me to approve reform legislation.

Our second big challenge with health care is the cost of care and health insurance. We all know what rising costs are doing to our families. Here are a few facts: 1. inflation in health care is two times the average rate of inflation in the general economy, and this has been true for many years. 2. within a few years, we are projected to spend 20% of our national economic output on health care, if no changes are made to the current system. This compares unfavorably to other advanced countries like Germany, France, and Canada---all of which spend 10-11% of their economic activity---half of what we do-- on health care, while, by the way, providing health care coverage for all of their citizens. 3. as a result of rapid rises in health care costs, employers are passing along a higher share of medical insurance premiums to employees---on average, you are paying more than double what you did less than 10 years ago.

My fellow Americans, the trends in health care spending, if we do nothing, will, as time goes on, make it less and less possible for us to invest in education, transportation, civilian and defense technology, basic research, national parks, and all the other vital public services and investments that we make at both the federal and state and local levels. Over time, health care spending will make us a poorer and weaker nation, unable to fulfill our commitments at home and abroad.

Our health care crisis has been a problem in the making for over twenty years. There will be no easy solutions, there will be no immediate solutions, there are no perfect solutions, but we must take action now. I ask you---if we do not act now, then when will we? We must not wait and leave the problem for our kids or their kids to tackle when it will be even more difficult and costly to act.

I have been labeled a lot of things during these last months while I and the members of Congress have been hard at work on solutions to this crisis. To some, I am a socialist, a communist, a Nazi, or just plain unAmerican for trying to make changes to a system that has so many problems. Well, I don't mind a little name-calling, because, after all, this challenge is not about me, this is about what is best for the American people. I defend the right of my opponents to disagree with me, even vehemently, but my challenge to them is simple: if you do not agree with my approach on this issue, come forward with your own plan that meets the challenges I pose to you tonight----affordable medical care for all and a solution with teeth that gets medical cost inflation under control.

Here's what we must do:

1. Require that all citizens be insured, whether through an employer mandate, expansion of Medicaid, or a new public insurance plan to be financed, in part, through targeted tax increases or repeal of tax breaks for the wealthy that were passed during my predecessor's Administration. Medical insurance must be an affordable right for all, and easily moved from one employer to another, with treatments determined by your doctor and not invisible decision-makers in private companies.

2. Cut the rise of medical costs to no greater than the general rate of inflation through a combination of laws restricting price increases for medicines, discouraging the use of costly treatments that have no proven track record of success, eliminating waste, inefficiency, and bureaucracy, and widening the choices for Americans through combinations of a public insurance plan, local cooperatives, and other federal and state-run initiatives. I strongly favor the creation of a public insurance plan option, modeled along the lines of several government run programs that work well for millions of our citizens---Medicare, Medicaid, and the Veterans Health Administration. Though all of these programs need constant review and improvement, I believe that a public plan is an essential component of a mix of options that we need to help contain health care inflation.

Your elected representatives in Congress along with dozens of members of my Administration, are working on the many fine points of the legislation we need to enact real reform. I ask each of you to get involved, ask questions, make your voice heard, help us to achieve the goals we all share--a durable, affordable, high quality health care system that treats each of our fellow citizens like first class citizens in this, the wealthiest nation on the planet. We can afford to do what we must, but I need your support, participation, and patience as we work through the details and finalize reform legislation. Nothing is decided until we put these proposed laws before Congress for a vote and then send to me for my signature.

My friends, you elected me on a platform of change, and I believe you provided me an electoral mandate to bring the changes we have needed for a long time to many of our essential public policies and services. That is what I intend to keep doing, with your blessings and support. The changes we seek are often not easy, but we Americans hunger for the big challenges and we have always risen to the occasion. I ask you to join with me to stay the course and insist that our legislators vote for real change so we can get on with the business of fixing our economy, meeting our commitments abroad, and ensuring peace and prosperity for our great nation.

Thank you. God bless America and good night.